Provider Demographics
NPI:1922120666
Name:AESTHETIC AND RECONSTRUCTIVE SURGERY PC
Entity Type:Organization
Organization Name:AESTHETIC AND RECONSTRUCTIVE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-352-3090
Mailing Address - Street 1:105 COLLIER ROAD
Mailing Address - Street 2:SUITE 3010
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1733
Mailing Address - Country:US
Mailing Address - Phone:404-352-3090
Mailing Address - Fax:404-352-8896
Practice Address - Street 1:105 COLLIER ROAD
Practice Address - Street 2:SUITE 3010
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1733
Practice Address - Country:US
Practice Address - Phone:404-352-3090
Practice Address - Fax:404-352-8896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44202Medicare UPIN